Summary: Mr B complained the Council failed to provide him with an adequate care package and adaptations to his house to enable him to live independently. We find the Council was at fault as there was a delay in allocating a social worker and putting a care package in place for Mr B. The Council has agreed to our recommendations to address the injustice caused by fault.

The complaint

1. Mr B complained the Council failed to provide him with an adequate care package and adaptations to his house to enable him to live independently. He says the Council’s failures means his medical condition has worsened and he has been deprived of his independence.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I considered information from Mr B. I made written enquiries of the Council and considered information it sent in response.
5. Mr B and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Assessments and care and support plans

6. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
7. If the council considers the person has eligible needs, it must provide a care and support plan. The plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.  The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
8. The council may charge the adult when it arranges care and support. The Care Act and supporting statutory guidance is intended to make charging fairer and more clearly understood by everyone. The overarching principle is that people should only be required to pay what they can afford. People will be entitled to financial support based on a means-test and some will be entitled to free care.

Disabled Facilities Grants

9. Disabled Facilities Grants (DFG) are for people with a qualifying disability who need certain adaptations in their home to help them remain in their home. They are mandatory and must be awarded if the applicant meets the qualifying conditions.
10. Grants are only approved if the council accepts the work is necessary and appropriate to meet the needs of the disabled person and it is reasonable and practicable to carry out the work. The assessment of need is usually completed by an occupational therapist.

What happened

11. This chronology provides an overview of key events and does not detail everything that happened.
12. Mr B was diagnosed with an advanced stage of a neurological disease in June 2021.
13. The Council received a referral in July from Mr B’s nurse. She said Mr B lived alone and she was worried about him falling, leaving his home, and accessing his garden. She asked for occupational therapy input for home adaptations and aides. She also asked for the Council to assign a social worker to discuss the different types of support available.
14. An occupational therapist (the therapist) visited Mr B in August. She assessed Mr B’s needs. Mr B said he was struggling to maintain his home, mobilise and access his toilet and bathing facilities. The therapist ordered a toilet frame, bath board, perching stool, kitchen trolley and furniture raisers. She referred Mr B to the Council’s Living Well department as Mr B said he was struggling to maintain his home.
15. The therapist visited Mr B when the equipment arrived. She agreed to complete a DFG request for major adaptations to his house.
16. Mr B went on holiday for two weeks. When he returned, he contacted his nurse and said the equipment was not suitable for his needs. The therapist contacted Mr B. Mr B said none of the equipment was working apart from the kitchen trolley. The therapist agreed to make a referral for grab rail to be installed beside Mr B’s toilet. Mr B asked about getting a bar stool for the kitchen. The therapist explained only the perching stool was available, but she would look to see if any others came back in stock.
17. An officer from the Living Well department visited Mr B on 7 September. Mr B said he would benefit from having a further assessment for care and support. The officer made a referral for the assessment on 9 September.
18. Another local authority (Council X) is responsible for processing DFG applications in the local area. The Council’s occupational therapists assess an individual’s needs and provides recommendations, and then the matter is passed to Council X to progress. The therapist confirmed she would provide Council X with her recommendations for the DFG.
19. Mr B’s nurse spoke to the therapist on 22 September and said he was struggling at home. The therapist said he was on the waiting list for a social care assessment, but she was unclear how long it would take.
20. The therapist arranged a joint visit to Mr B’s house on 12 October with representatives from Council X to discuss the DFG adaptations. All parties agreed that a through-floor lift, rather than a stair lift, would be appropriate for Mr B’s needs. They also agreed the doors would need to be widened in his house. Mr B said he would investigate getting this done himself. There was not enough time to look at the bathroom adaptations, but an officer from Council X agreed to review it further on another visit.
21. Mr B’s nurse contacted the Council and said he needed help with his personal care needs. She asked for it to complete an urgent assessment under the Care Act 2014.
22. The therapist had a telephone call with Mr B. He said he could not access his toilet for three days. The therapist offered to order a commode as there was no other standard equipment available for his toilet. Mr B declined as he said there was no one to empty it.
23. Mr B said he was struggling to care for himself. The therapist said she would contact the manager of the social care team to reiterate the urgency.
24. The Council allocated a social worker to Mr B’s case on 2 November. She completed an assessment of his needs on 23 November. She identified that he had eligible care and support needs. She said his needs would be best met at home with support for personal care and meal preparation.
25. The therapist attended another meeting at Mr B’s house with a representative from Council X. Council X said there was enough space in Mr B’s house for bathroom adaptations, and the earliest date work could start was March 2022. It said it would continue to work on the plans for the adaptations.
26. Mr B said he was struggling to use the stairs. He asked for a second banister and a grab rail. The therapist agreed to pursue the matter and re-visit with a representative from the agency responsible for such matters. She also said she would order a raised toilet seat for him. Mr B said he would consider moving into social housing. The therapist said she would contact the team at Council X to see whether he was eligible.
27. The therapist visited Mr B at his house with an officer from the agency. The officer explained due to the type of walls in his stairwell, he would not be able to install any more rails. He agreed to ask for a quotation for a different option. The therapist said she had made a referral for Mr B to get some support in completing a housing application. Mr B said the raised toilet seat was working well.
28. The Council made referrals to various care agencies for a care package for Mr B in December and January 2022. They all replied and said they had no capacity.
29. The Council contacted Mr B’s daughter. It suggested Mr B could have some respite care away from home until it sourced a care package. Mr B’s daughter said she would discuss the matter with him, but it was unlikely he would agree as he preferred having support at home.
30. Council X contacted the therapist and said it would not complete any further work on the DFG until Mr B decided where he wanted to live.
31. The therapist spoke to Mr B. He said he had decided not to move, and he did not want to delay the DFG process. The therapist also provided Mr B with the quotation for a different rail. Mr B decided not to pursue it.
32. The Council sourced a care package for Mr B which started on 10 February. This consisted of carers coming in three times a day to help with meal preparation and his personal care.
33. Council X contacted Mr B and said he would need to complete private works to widen his doorway before the DFG works could start.
34. The therapist emailed Mr B on 15 February and said it had received a phone call from a senior carer asking for a riser recliner chair for him. She said she would discuss it with his nurse.
35. Mr B and the care agency agreed it was not a good match and so the care package ended on 2 March.
36. The Council provided Mr B with reablement care, short-term care designed to help people regain their independence, from 3 March. This consisted of carers coming in to provide support twice a day.
37. The therapist noted on 23 March she did not have any capacity to get a quotation for the rise recliner chair. She said she had asked another occupational therapist to try and get a quotation.
38. The Council received concerns from Mr B’s healthcare professionals about the deterioration in his condition. The carers from the reablement team noted Mr B’s needs were changing and it could not provide the level of care he needed.
39. The Council discussed with Mr B whether he would agree going into a hospice for some respite care. Mr B agreed to this. He went into a hospice at the beginning of April.
40. The Council contacted some other care providers throughout April to see if they could meet Mr B’s care and support needs when he was discharged from the hospice.
41. A member of staff from the hospice contacted the Council about the adaptations to Mr B’s house. The Council responded and explained Council X told Mr B several times he needed to complete the private work before the DFG work could start.
42. Mr B complained to the Council on 27 April about the Council’s failure to provide him with appropriate assistance. He also said there had been delays with the major adaptations to his house going ahead.
43. The Council contacted Mr B on 13 May. It said it had found a care package for him. Mr B declined the care package and said he would not come home until the adaptations to his house were complete.
44. Mr B accepted a quotation for the private works on his house. Council X agreed to approve the DFG paperwork.
45. The Council responded to Mr B’s complaint on 15 June. It said it provided him with support from 10 February to 2 March, but both parties eventually agreed this was not a good match. It also said when its reablement team provided support, his condition deteriorated further. Therefore, he agreed to go into a hospice. Additional health support was the best option to assess his changed needs. It also said it provided him with equipment in a timely manner. Finally, it said there was a slight delay in sending the DFG recommendations to Council X, but this was due to the therapist being unwell.
46. The Council found a short-stay placement for Mr B in a care home on 23 June. After a few days, Mr B raised concerns the placement was not suitable for him. The Council made referrals to several other agencies.
47. The Council found an apartment for Mr B to move into. Mr B visited the apartment and said he was happy with it, but it would need some minor adaptations to meet his toileting needs. The Council confirmed it would adapt the apartment to suit his needs.
48. Council X started the DFG works. Mr B decided he would stay at the care home and return home when the work was complete rather than moving to the apartment.
49. Council X contacted the Council and explained the supply and fitting of the lift in Mr B’s house would not be complete until January 2023.
50. The Council met with Mr B. It explained it had found him a care package for when he returned home. It also suggested it could try and source an overnight carer for the first two weeks of his return home.
51. Mr B has now been awarded Continuing Health Care (CHC) funding. CHC is a care package for adults which the NHS arranges and funds. Therefore, the Council is no longer involved in the management of Mr B’s case.

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Analysis

52. There was some delay in the Council allocating a social worker to Mr B’s case. The officer from the Living Well department made a referral on 9 September, but a social worker did not assess Mr B’s needs until 23 November. During this time, the Council received phone calls from Mr B’s medical professionals highlighting the urgency of the matter and that he was struggling without support.
53. There was a further delay with the Council’s putting a care package in place. The social’s worker assessment from 23 November identified Mr B had eligible care and support needs that would be best met with carers supporting him at home. However, it did not find a care agency and start the care package until nearly three months later. The Council accepts it had difficulties finding a care agency, but it also says it offered Mr B respite care during this time and he did not pursue this option.
54. I accept Mr B did not pursue respite care at the time. However, the outcome of the Council’s assessment was for Mr B to receive care and support at home, not respite care away from home. There is nothing in the Council’s assessment that said respite care was appropriate or suitable for his needs. Therefore, the Council’s delay in sourcing a care package was a service failure, which caused Mr B frustration and distress.
55. Mr B says he was left to die alone in the hospice without any action taken. He says the social worker did not contact him for weeks. I do not accept the Council took no action when Mr B was in the hospice. The evidence shows it got in contact with several other care providers to source a care package for Mr B for when he was discharged. However, Mr B decided it was not appropriate for him to return home until the DFG works were complete. The Council also spoke to staff at the hospice regularly about Mr B’s case and how to move things forward.
56. Mr B’s social worker did not contact him for several weeks as she was on annual leave. Duty social workers did speak to staff at the hospice on several occasions. However, the Council did not contact Mr B directly and provide him with any contact details for alternative social workers while his allocated social worker was away from work. This is fault, which caused Mr B frustration at the lack of communication.
57. The Council worked with Mr B to try and find a solution to meet his care needs. When he said he did not want to return home until the DFG work was complete, it found a short stay placement in a care home for him. When he raised concerns about the placement, it acted quickly to find other alternatives. Mr B decided he would not pursue the apartment and he would stay in the care home until the DFG works were complete.
58. With regards to the minor adaptations to Mr B’s house, the therapist acted in a timely manner most of the time. She ordered the equipment quickly after her first meeting with Mr B. When Mr B raised concerns this equipment was not suitable for him, she tried to explore other options. Mr B’s needs changed significantly, and so the therapist had to adapt and order new equipment as time went on.
59. The therapist did delay pursuing the riser recliner chair. She said she would investigate this in February. By the end of March, she noted she did not have any capacity to pursue this any further. This delay would have caused Mr B some frustration. However, Mr B went into the hospice in April. Therefore, even if the therapist had pursued it sooner, it is not clear whether it would have been delivered in time and whether he would have got much use out of it.
60. Mr B says the Council delayed dealing with the DFG. Council X oversees the DFG. The Council’s role is to provide any recommendations to Council X. Council X is then responsible for drawing up any plans, finding contractors and completing the work. I am satisfied the Council provided its recommendations to Council X within a reasonable timescale. There was a short delay because the therapist was away from work, and she wanted to discuss the case with a senior colleague. This delay is relatively minor and not significant enough to be fault. As soon as she returned, she acted quickly to follow matters up. She attended several meetings with Council X and liaised with representatives. I have found no significant delay on the Council’s part. Mr B is free to pursue a complaint with Council X if he is dissatisfied with its handling of the matter.

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Agreed action

61. To address the injustice caused by fault, by 9 February 2023 the Council has agreed to:

• Apologise to Mr B.
• Pay Mr B £300 for his frustration and distress.

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Final decision

62. I have found the Council, which caused Mr B an injustice. The Council has agreed to my recommendations and so I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman